Eight-year-old Tommy has trouble paying attention in school, is always restless in class, unable to complete his tasks, hyperactive both in school and home and his teacher discusses the possibility of him having ADHD with his parents. They decide to take him to see a pediatric psychiatrist. After some analysis, he’s diagnosed with ADHD, prescribed with Ritalin and is on his way home with his medicine. Classic childhood ADHD story, right?

What happens to young Tommy 20 years down the road? Now, he is 28 years old, and it’s been some time since he stopped his medication because he no longer “needed it” or “grown out of it.” He has trouble focusing on tasks at work, is fired from multiple jobs and has a hard time keeping his life on track. He’s sad, unmotivated, hopeless, can’t seem to find interest in anything and turns to alcohol for comfort. He goes in to see a psychiatrist, he’s diagnosed with depression and is prescribed with antidepressants and on his way home. What’s wrong with this picture? Why is it that we take child ADHD so seriously, but when the child turns into a young adult its as if the condition has disappeared? Why do we turn a blind eye to adults that believe they suffer from ADHD? What happens to him now in his day-to-day life, inability to stay focused, finish his tasks and be the best he can be?

According to research, ADHD is found in approximately 4.4 percent of U.S. adults. This is just the reported amount, as there are numerous undiagnosed or misdiagnosed cases. In adult presentations, there’s a stigma that if you present with ADHD symptoms, you just have to learn to focus or you can fix it if you really try hard enough. Why is that? Many people have a lack of understanding on ADHD in adulthood, and when faced with the challenges, it takes a toll on their emotional standpoint. In medical school, we focus on the prevalence of ADHD in children, the diagnosis of inattention in two settings (i.e., school/home), but we never touch on the topic of the continuation in adulthood. The stigma of ADHD in adulthood has become so taboo, that patients rarely bring it up with their primary physicians and fit their presentation into another subsect of mental illness. The ADHD spectrum is so broad with overlapping symptoms, yet so poorly understood.

There are patients that may need medication on a daily basis for basic tasks and activities. On the other side, someone might just need it for a specific project that requires extra concentration. Most adults diagnosed with ADHD are found to be highly intelligent individuals who have a hard time executing at their highest potential. I was uneducated about the topic until I came across Dr. Hoffer (an adult ADHD specialist), whom I had the pleasure of shadowing for some time.

My eyes were opened dramatically to this topic and the struggles ADHD adults faced as opposed to the children. There was a giant variety of age from students dropping out of college unable to finish their degree, to 65-year-olds wishing they had been diagnosed in their twenties. I saw the drastic changes in these patients and their complete transformations firsthand. As Dr. Hoffer describes it, ADHD isn’t an illness, but a functioning issue. If you can’t function at your highest potential, we would all be depressed. Just like you would wear glasses to correct your sight, some patients might find they need help to clarify their way of performing.

ADHD is tricky as it presents differently in adults than it does in children, but the underlying problems are constant. As children are supervised by teachers and parents at home, they have someone monitoring their attention and focus and behavior. As for adults, other than our boss who may have a slight idea of how we perform at work, there is no one else keeping tabs on us. Hence, this is harder to spot because it shows up in a different manner. Anger, depression, and anxiety are all feelings that stem from feeling inadequate in our job performance, family life, personal and financial life. Patients usually jump from one job to another, having trouble working with co-workers or performing tasks at hand. They have a hard time keeping stable relationships, whether intimate or professional. This also causes a higher divorce rate. All these factors lead to the constant feelings of depression, decrease motivation, energy, sleep disturbances, concentration and hence depression takes over and masks the actual problem which is ADHD. No wonder so many patients are being misdiagnosed with depression.

With more of an understanding of ADHD, patients with children that also have ADHD will have better means of communication on how to go about dealing with it. ADHD is indeed genetic, and, therefore, your children will have a higher chance of getting it if you do. Studies have also shown that there was a direct correlation between higher number of substance abuse cases (alcohol, cocaine, marijuana, etc.) within the ADHD adult community. Dealing with these mental and emotional challenges also lead to a higher suicidal rate.

With all of this said, there is a high number of abuse within the class of stimulant drugs. We need to be cautious when prescribing to make sure we aren’t encouraging abuse potential. And we should weed out malingering patients.

There’s no way everyone who steps into your office claiming to have ADHD will have it, nor will they need medication. This is just the beginning of a discussion about how we should be more mindful of ADHD in adults and ways to help. Behavioral therapy is useful, meditation, exercise and some alternative methods, including natural remedies and even some video games, have been proven to be found to be helpful in patients.

There are also many diagnoses in between the spectrum that need to be understood. This is just an emphasis on how ignoring and placing a stigma on ADHD in adulthood needs to come to an end. Next time a patient walks into your clinic and presents with the classic depression case with the SIG E CAPS symptoms, take a moment to dig deeper as to where these symptoms are arising from. Just like you would assess for underlying medical conditions, take it a step further and asses other functioning issues.

Deenuka Kasinather is a physician.

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